GP Network Plan – 2020 Comparisons

gp network plan south africa woman child doctorGP Network Plan: Are generally designed for younger people entering the medical aid market for the first time or for those clients that have a limited medical aid budget.

The Medical Aid companies generally contract with a group of hospitals and GP’s on a capitation* basis and in this way are able to offer medical cover at more affordable rates.

*Capitation means that a member will be able to visit his/her chosen GP without having to pay for the consultation. The Medical Aid agrees to pay a monthly amount to the GP, regardless of how often the member visits that GP.

GP Network Plan Members generally need to work through their GP (the Gatekeeper), regardless of the particular ailment.

With spiraling medical aid inflation, the Network Plans have become far more popular in the last few years.

View our latest 2020 plan updates below.

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GP Network Plans2020 Comparisons Made Easy!

DISCOVERY
KEYCARE PLUS - Network Plan
MONTHLY CONTRIBUTIONS
Income p/m R0-R8,550 R8,551-R13,800 R13,800 +
Principal Member R 1,207 R 1,659 R 2,450
Spouse/Adult Dependant R 1,207 R 1,659 R 2,450
Per Child (Max 3) R 439 R 468 R 656
IN HOSPITAL BENEFIT
2020 BENEFITS
100% Scheme Rate
No Overall Annual Limit
Full Cover Network Hospitals to be used.
Certain procedure only covered at Network Day Clinics.
Annual Sub-limits per person:
Psychiatric Treatment

21 days
Hospice Care

R 48,200
Oncology

PMB








CHRONIC MEDICATION
100% Scheme Rate
27 PMB Chronic Disease Conditions.
Subject to scheme formulary.
Only from a Network Pharmacy or chosen GP.
ANNUAL DAY TO DAY BENEFIT
(including Savings)
100% Scheme Rate
GP's No Limit from KeyCare Network Providers.

(4 out-of-network visits)
Specialists: R 4 400 per person from Network Providers.

(must be referred by Network GP)
Conservative Dentistry: No Limit from KeyCare Network Providers.








ANNUAL THRESHOLD
Does not apply








DISCOVERY
KEYCARE START - Network Plan
MONTHLY CONTRIBUTIONS
Income p/m R0-R9,150 R9,151-R13,800 R13,801+
Principal Member R 914 R 1,538 R 2,394
Spouse/Adult Dependant R 914 R 1,538 R 2,394
Per Child (Max 3) R 550 R 601 R 650
IN HOSPITAL BENEFIT
2020 BENEFITS
100% Scheme Rate
No Overall Annual Limit
Full Cover Network Hospitals to be used.
Certain procedure only covered at Network Day Clinics.
Annual Sub-limits per person:
Psychiatric Treatment

21 days
Hospice Care

R 48,200
Oncology

PMB








CHRONIC MEDICATION
100% Scheme Rate
27 PMB Chronic Disease Conditions.
Subject to scheme formulary.
Only from a State Hospital
ANNUAL DAY TO DAY BENEFIT
(including Savings)
100% Scheme Rate
GP's No Limit from KeyCare Network Providers.

(2 out-of-network visits)
Specialists: R 2 200 per person from Network Providers.

(must be referred by Network GP)
Conservative Dentistry: No Limit from KeyCare Network Providers.








ANNUAL THRESHOLD
Does not apply




FEDHEALTH
MYFED - Network Plan
MONTHLY CONTRIBUTIONS
Income p/m R1-R6,251 R6,252-R10,219 R10,220-R12,622 R12,623-R14,426 R14,427+
Principal Member R 1,023 R 1,297 R 1,818 R 2,310 R 3,133
Spouse/Adult Dependant R 893 R 1,126 R 1,587 R 1,904 R 2,854
Per Child (Max 3) R 492 R 634 R 697 R 903 R 1,194
IN HOSPITAL BENEFIT
2020 BENEFITS
100% Scheme Rate
No Overall Annual Limit
Network Hospitals to be used.
R12 000 co-payment on voluntary
non-network admissions.
*7 days Take Home Medicine
*Emergency Trauma at Out Patients
Psychiatric Treatment



R 9,100
Hospice Care



n/a
Oncology



PMB
Internal Prosthesis



PMB
CHRONIC MEDICATION
100% Scheme Rate
27 Chronic Disease Conditions.
Subject to Basic Scheme formulary.
Only from Medi-Rite, Clicks, Dis-Chem &
Pharmacy Direct.






ANNUAL DAY TO DAY BENEFIT
(including Savings)
100% Scheme Rate

GP's No Limit from Network Providers.

(2 out-of-network visits)






Specialists: 2 visits limited to R 1 800 per person from Network Providers.

(must be referred by Network GP)




Conservative Dentistry: Only from a Network Provider.

(Fillings, extractions, consultations)

Plastic dentures limited to one set per person every 2 years.


ANNUAL THRESHOLD
Does not apply


















MOMENTUM INGWE OPTION
INGWE NETWORK HOSPITALS - Network Plan
MONTHLY CONTRIBUTIONS
Income p/m R0-R725 R726-R7,150 R7,151-R9,450 R9,451-R13,500 R13,501+
Principal Member R439 R 905 R 1,151 R 1,602 R 2,269
Spouse/Adult Dependant R439 R 905 R 1,151 R 1,602 R 2,269
Per Child R396 R 414 R 430 R 471 R 668
IN HOSPITAL BENEFIT
2020 BENEFITS
100% Scheme Rate
No Overall Annual Limit
*7 daysTake Home Medicine

Annual Sub-limits per person:
Psychiatric Treatment



PMB
Hospice Care



n/a
Oncology (at a State Hospital)



PMB












CHRONIC MEDICATION
100% Scheme Rate
26 Chronic Disease Conditions.
Subject to scheme formulary.
Ingwe Primary Care Network.

ANNUAL DAY TO DAY BENEFIT
(including Savings)
100% Scheme Rate
Primary Care Network.
GP's No Limit from Ingwe Primary Care Network.

Pre-authorisation required from 11th visit.

1 out-of-network visit per person and max 2 visits

per family per year with a R100 co-payment.


Specialists: 2 visits per family per year limited to R1 050 per person

and R2 100 per family.

Must be referred by a Network GP


Conservative Dentistry: No limit from Network Providers.

Pre-authorisation required if more than 4 fillings

or extractions.


ANNUAL THRESHOLD
Does not apply












As additional GP Network Plan comparisons are made available we will continue to update this page in our effort to provide our clients with the most up to date information and advice on the medical aid industry in South Africa. If you are still deciding which plan type is best suited to your situation, why not take a look at the Medical Aid Plans page to see the full range of plans.

For more detailed information on any of the above GP Network Plan comparisons simply contact us. If you already know what you want, why not make use of our site to download the relevant Medical Aid Application form and then fax it back to us on 0866 200 320 . Alternatively, if you would like us to confirm some of the finer details and pricing just fill in our free Medical Aid Quote Request form and we will get back to you promptly.

Finally, we invite you to contact us on +27 21 712 8866 at any point in your decision making process for further information on these GP Network Plan comparisons.

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